Chalazion, also known as chalazion, is a chronic inflammatory granuloma of the lid gland based on obstruction of the lid drainage ducts and retention of secretions, and is a common condition that can affect both children and adults. The disease is slow to progress and can be recurrent. The disease presents as a hard, painless, palpable mass on the eyelid with elevated surface skin. It can occur on both the upper and lower lids and can be single or multiple, and can vary in size. In most cases, the lumps remain unchanged for a long time or grow gradually, sometimes breaking down on their own and discharging gel-like contents, or forming dark red granulomas under the skin.
In most cases, the masses remain unchanged for a long time or grow gradually, sometimes breaking down on their own and discharging gelatinous contents, or forming a dark red granuloma under the skin. When the disease occurs in the elderly and has a tendency to recur, it needs to be differentiated from adenocarcinoma of the lid and the contents should be sent for examination.
Chalazion is a granulomatous inflammatory disease containing giant cells. Due to the storage of sebum in the lid gland, it can cause chronic inflammation around the lid gland and ducts, resulting in the formation of specific granulation tissue that does not septicize. The pathologic changes are characterized by round cell infiltration around the first bleb glandular follicles, epithelial cell hyperplasia, and rapid formation of granulomas within the glandular tissue and its adjacent lid containing plasma cells, epithelioid cells, lymphocytes, giant cells, and large amounts of fibrotic tissue. The surrounding tissue is densely packed into a capsule, with fibers forming early in the capsule and degenerative liquefaction in the central portion due to ischemia, which forms a cyst-like lesion when completely liquefied.
The main clinical manifestations are.
1. small cysts have no conscious symptoms, while larger ones may have a heavy discomfort;
2, there are hard nodules under the lid skin, no adhesion to the skin, no pressure pain, the corresponding lid conjunctival surface is purple-red or purple-blue, gray-white over time, the nodules can remain unchanged for years or slowly enlarged;
3, secondary infection, performance like internal wheals, can form inflammatory granuloma.
The cause of chalazion formation is not very precise, and may be related to a variety of factors. The more likely causes are.
1. chronic inflammation of the eyelid, such as conjunctivitis or blepharitis, causing obstruction of the glandular drainage opening;
2. Commonly seen in children, this may be related to their metabolic disorders, glandular secretion and proliferative capacity;
3. Marginal vitamin A deficiency and subdeficiency may be associated with chalazion multiforme in younger children;
4, the use of cosmetics is also a predisposing factor.
Chalazion can be divided into conjunctival surface type and skin surface type according to the site of occurrence. The conjunctival surface type is dark red in color. The swelling does not develop towards the skin surface of the eyelid, this child can be operated by the conjunctival surface of the eyelid, after surgery, the eyelid does not leave a scar. The dermatofacial pattern is characterized by a chalazion granuloma that progresses to the skin of the eyelid and gradually increases in size. The chalazion can have a large amount of hemorrhagic necrotic tissue in the cavity of the mass. This type of chalazion is complex and if not treated aggressively, the cyst will eventually rupture, leaving a large irregular scar tissue on the skin surface and in severe cases an ectropion of the eyelid caused by a skin surface defect.
The main risks of chalazion include.
1. A single, hard chalazion in the central area of the upper eyelid can reduce corneal astigmatism and regularity, which can cause more astigmatism and therefore may cause amblyopia in children;
2.Surgery or self-breakage of the chalazion forms a scar, which affects aesthetics, and scar contraction even causes eyelid ectropion and deformity;
3. Multiple chalazia may occur repeatedly;
4. It may cause dry eye after surgery.
Diagnosis basis.
Patients usually have no conscious symptoms, there is a nodular elevation under the eyelid skin, no pressure pain, no adhesion with the skin, turn the eyelid, facing the conjunctiva of the cyst and it is purplish or grayish white (the cyst can be pierced from the conjunctival surface to reveal granulation tissue).
Treatment.
Small blepharospasm cysts may recede on their own and disappear completely. Smaller lumps that remain unchanged for a long time, have no obvious symptoms, and do not affect the aesthetic appearance may not require treatment or may be treated by applying heat to the lid. For small, persistent lid cysts or those with self-induced symptoms, hot compresses and physiotherapy massage therapy, or injections of 0.3 to 0.5 ml of prednisolone around or into the cyst, can promote absorption. Those with larger masses or gradually increasing in size, or those with obvious self-conscious symptoms and discomfort need surgery. For recurrent and multiple cases, surgery combined with TCM treatment. The incision is usually made on the conjunctival surface, perpendicular to the lid margin. Closed pressure is applied to stop bleeding and no sutures are required. In cases where the skin has broken down or is about to break down, the surgical incision is made on the skin surface, parallel to the lid margin, and sutures are required to close the wound.
If the gelatinous material cannot be scraped out during excision, especially in older patients, the possibility of adenocarcinoma of the lid should be considered and a piece should be excised and sent for pathology for clarification. In children with a ruptured lid gland cyst forming a purplish granuloma, the granulation tissue should be removed as much as possible. In children who cannot cooperate with surgery, anesthesia-assisted surgery is recommended.
Surgical considerations.
1. The cyst wall must be removed during surgery to prevent recurrence;
2. If the granulation tissue is protruding from the conjunctival surface, it should be cut out at the same time;
3. In children, if the lid gland cyst breaks down and forms a purplish granuloma, the granulation tissue should be removed as much as possible;
4. If gelatinous material cannot be scraped out during excision, especially in elderly patients, the possibility of adenocarcinoma of the lid should be considered and a piece should be removed and sent to pathology for clarification.
Lid gland massage technique.
With the patient lying on the bed, the physician first cleans the patient’s eyes, then dots them with anesthetic, and after 1-2 minutes of silence, with the eyes looking down, the physician pinches up the patient’s upper lid to expose the upper lid margin and massages the conjunctival surface of the lid at the lid margin with a sterile glass rod; then massages the lower eyelid, with the eyes looking up, and presses the lid margin with a sterile glass rod to exclude the lipid-like material in the lid gland and to open the lid gland. The secretions are swabbed away with a sterile saline swab after pressure.
The prognosis for chalazion is good, but it is prone to recurrence. If the mass gradually increases in size, it will rupture on its own, and after rupture, the gel-like material will flow out and form a pyogenic granuloma; the wound at the skin rupture is not flush and may leave a scar, so surgery is appropriate; surgical scars may also remain at the surgical incision, but the incision is usually flatter than if it ruptures on its own. The contraction of the surgical scar can cause ectropion, entropion, and eyelid deformity, so secondary surgery may be considered.
So how do you prevent chalazion?
We can actively prevent it in our daily lives by adjusting our diet, regulating the spleen and stomach, massaging the lid gland, local anti-inflammatory, and reducing the incidence of blepharitis and conjunctivitis. Chalazion is caused by the blockage of the lid glands by abnormal lipids. It predominates in infants and children aged 1-3 years. At this age, an incomplete diet, inadequate intake of dietary fiber such as fruits and vegetables, and excessive consumption of greasy and fried foods can induce chalazion.
Some children are predominantly formula based and current imported formula is mostly large fatty particles that can cause obstruction of the chalazion glands in Chinese children. The theory in Chinese medicine is that the onset of chalazion is associated with spleen and stomach disharmony, liver fire, food accumulation, and constipation. Local application of anti-inflammatory medications along with a combination of Chinese herbs for systemic conditioning is needed and can be preventive. Regular visits to the hospital for lid gland massage to resolve lid gland obstruction and avoid further chalazion.
Children with a tendency for recurrent or multiple chalazia can be reviewed 1-2 months after surgery, and if obstruction by the lid gland orifice is present, timely local clearance and examination for early budding masses and regular lid gland massage to unblock the lid gland orifice can play a role in preventing recurrence. In some patients, there is local inflammation of the lid gland, so anti-inflammatory medications can be applied for a certain period of time to alleviate symptoms and reduce the recurrence rate. In patients with recurrent blepharitis and conjunctivitis, topical anti-inflammatory and anti-infective eye medications may be required, and attention should be paid to eye cleanliness and hygiene.
Chalazion is a common and frequent disease in childhood, and we need to actively prevent it, eat properly, diagnose it early, and treat it early to avoid the formation of large scars that can cause eyelid deformities and affect the aesthetics, thus hindering the physical and mental health of the affected child.